Homeland: Just how realistic is it?

Consultant psychiatrist speaks about hostages and the problems of homecomings

It is President Obama’s favourite TV show, and its British star was among those invited to the state banquet in the White House in honour of David Cameron on Wednesday.

Few would doubt that HBOs ‘Homeland’ is a pretty accomplished TV-thriller; but is it realistic?

In the US, reviewers appear to have focussed on the implausibility of the CIA character, agent Carrie Matheson, played by Claire Danes. She is the investigator trying to establish whether US Marine Sergeant Nicholas Brody (Damian Lewis) is actually an al-Qaida terrorist in disguise.

Brody, afterall, has been held hostage in Iraq for eight years, long enough perhaps, to have been ‘turned’ by his captors.

There is a major flaw in this set-up – as the New York Post pointed out in October last year. The CIA is a bit like our MI6 – their focus is abroad.

Running down a possible terrorist here in the US is really a job for domestic law enforcement agencies, such as the Departments of Justice and Homeland Security — not the CIA. Simply put: The CIA generally fights terrorism overseas, while the FBI and others handle it here, especially when it involves a US citizen like Nick Brody.

But the thing that troubled me is this: how come Brody doesn’t appear to have had any proper care after his return? Not in the first three episodes anyway.

He is left to attack reporters and shoot deer with his gun. He only agrees to go to a veteran’s support group after his wife orders him too.

Although unlikely these days, the lack of psychiatric assessment for someone who’d been held hostage isn’t quite as preposterous as you might think, according to consultant psychiatrist, Walter Busuttil.

In the past, he says, freed American hostages have not always been given close care after their release. Busuttil knows about these things. He is a former RAF wing commander who helped look after British hostages held in Beirut during the 1980s and early 90s.

He has written academic papers on the subject of hostages, including one for the Royal Army Medical Corps Journal, called Prolonged Incarceration:effects on hostages of terrorism.

Busuttil is now medical director of Combat Stress, the charity which specialises in the mental health care of former members of the armed forces.

With the Beirut hostages, the British hostages recieved help. I was part of the team. But some of the American ones did not get get help. I imagine it would be at matter of course now. You have to have someone to help with the reunion and reintegration with the family.

That does not necessarily need constant psychiatric care, but the hostage would have been screened first by a psychiatrist to see whether there were any obvious mental health problems

There are all kinds of things that need to be considered – and all kinds of conditions that might not manifest themselves for months, or even years.

You have to try to assess the impact of potential pscyhological problems before someone has been taken hostage. And then look at all the experiences they have have faced when they were being held.

The hostage may have been subjected to mock executions and torture. He may have been put in a situation where he heard or saw torture. He may have been confined and had his orientation taken away, so he has no idea of the time of day, or day of the week.

He may have faced psychological double-binds (where there are only unfavourable answers to questions). All these are likely to lead to mental health problems, and not just broad post-traumatic stress disorder.

You have to look at relationship between the hostage and the captor. Is he showing signs of sympathy towards his captor, the Stockholm syndrome. Or is the captor showing sympathy to the hostage, the Lima syndrome?

In ‘Homeland’, Brody returns home and is thrust infront of the press. After a debriefing, he is allowed home without any obvious pastoral care for either him, or his wife, or their two children. This is not what anyone would call best practice, says Busuttil.

He says members of the family would definitely need help too, especially if they have finished a period of ‘anticipatory grief‘.

There would have to be psychological input behind the scenes. The reintegration and reunion process has to take place in a private setting, without exposure to the press.

One would expect there would be regular visits to the majority of people to start with and there would be reviews over a year or two. In some cases problems don’t materialise for some time, and they are not just issues for the hostage.

There are issues for a wife, for instance, who may have had an affair during the time he has been away. The family has to cope when someone isn’t there. They may have grieved already and thought he’s not coming back.

That grieving process might have been completed, and the wife may have decided he is dead. Children will usually follow the lead from their mother. The way the wife copes will determine how the children cope.

If she has already completed her anticipatory grief by the time he comes home then the relationship is in big trouble. It can lead to to drug use and more reckless behaviour. Someone has to oversee the reunion and reintegration issues.

Busuttil hasn’t seen Homeland, and knew nothing of the plot. But speaking to him made me wonder whether the producers may have been reading him.

from Nick Hopkins

via http://www.guardian.co.uk/tv-and-radio/2012/mar/16/homeland-realistic